CT Scans in Trauma Patients Reveal More Incidental Findings

Action Points

Explain to interested patients that about a fifth of trauma patients who had a CT scan of the cervical spine had incidental findings, including fractures of the ribs, thoracic spine, and skull, as well as osteoporosis and emphysema.

Note that likelihood of incidental findings increased with age and injury severity score.

COLUMBUS, Ohio, March 5 -- Physicians are finding an increasing number of previously unrecognized injuries and conditions when they conduct cervical spine CT scans on their patients, researchers here said.

In nearly fifth of trauma patients who underwent a CT scan of the cervical spine during an initial trauma evaluation, there were incidental findings, including fractures of the ribs and skull, as well as osteopenia, osteoporosis and emphysema, Shella Farooki, M.D., of Grant Medical Center, and colleagues reported in the March issue of the American Journal of Roentgenology.

"A lot of patients come into the ER as trauma patients, but are leaving with diagnoses that are not related to trauma," Dr. Farooki said.

Reports of incidental findings in brain and chest scans are well-documented, the researchers said. However, there is a paucity of literature on incidental findings in cervical spine CT.

So, to determine the frequency and types of incidental CT findings, the researchers assessed 1,256 patients who had a CT of the cervical spine at Grant Medical Center between January 2007 and July 2007. Most patients had been involved in motor vehicle crashes and falls.

Any finding other than C1-C7 cervical spine injuries were categorized as incidental.

There were 197 patients with one finding (85.7%), 32 with two findings (13.9%), and one patient with three findings (0.4%).

The most common trauma-related findings included fractures of the ribs, thoracic spine, skull, and other locations (5.7%), followed by pneumothorax (1.7%).

Common nontrauma-related findings included spinal or foraminal stenosis (2.9%), osteopenia and osteoporosis (1.5%), and emphysema (1.3%).

The researchers said the lungs were the most common site of incidental findings, followed by the spine, skull, or face, and ribs.

Scans of patients 50 and older were more likely to produce incidental findings (29%, P<0.0001) than scans of younger patients.

Patients with more serious injuries were also more likely to produce CT scans with incidental findings (29% of those with severity scores above 16, P<0.0001) than less seriously injured patients.

In stratifcation by type of incidental fnding, 21% of patients 50 years and older had a nontrauma-related fnding, and 23% of patients with serious injuries had a trauma-related fnding.

"Clinicians treating a similar patient population should expect to encounter a clinically relevant incidental finding fairly frequently," the researchers said.

The researchers noted that the proportion of patients with an incidental finding varied somewhat according to the type of incident that produce the injury (P<0.0144), with falls having the highest percentage of incidental findings (24.4%) and motor vehicle crashes having the lowest (14%).

The findings are notable because "mismanagement of some incidental findings can have a devastating effect on patients," the researchers added.

Though the study may be limited by a lack of generalizability, the researchers said that "diligent and focused follow-up management of incidental CT findings can result in early and appropriate patient care, presumably effecting a positive clinical outcome."

"As imaging technology increases in sensitivity we will continue to detect and manage unexpected pathologic findings and must form protocols to manage these findings consistently and appropriately," they added.

The researchers reported no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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